Comparison of immediate and intermediate-term outcomes of intravascular ultrasound-guided versus angiography-guided intervention for type C coronary lesions

Background: the intravascular ultrasound [IVUS] is an invasive access technique that allows analysis of characteristics [qualitative and quantitative] of coronary atherosclerosis. Percutaneous coronary intervention [PCI] of complex lesions [i.e., American College of Cardiology/ American Heart Association class type C] remains challenging and the outcome may be compromised. The use of intravascular ultrasound [IVUS] to guide PCI was suggested to improve outcome

Objectives: aim of this study was to compare intravascular ultrasound-guided and angiography-guided Intervention for Type C coronary lesions regarding major adverse cardiac events [MACE]

Patients and Methods: Our study was conducted on patients undergoing elective PCI for type C coronary lesions in Cardiology Department in Ain Shams University hospitals. The study included 50 patients who underwent IVUS guidance PCI for Type C lesions and 50 patients who underwent only angiographic guidance PCI for Type C lesions. We evaluated the impact of IVUS guidance on clinical outcomes of patients undergoing PCI for complex lesions defined as ACC/AHA type C. Major adverse cardiovascular events [MACE], a composite end-point of all-cause mortality, Q-wave myocardial infarction and target lesion revascularization, were compared between the 2 groups. Mean follow-up duration was 12 months

Results: baseline clinical characteristics were similar in both patient groups. Adding IVUS to the procedure lengthened the procedure time. On the other hand, lower amount of radiographic contrast was required in the IVUS guided group during the procedure. Regarding the target coronary vessel in our study was similar in both groups with no significant difference. In addition, the number of ostial, proximal, mid and distal lesions was similar between the two studied groups. Patients with IVUS-guided PCI underwent more direct stenting, more postdilatation, larger maximal stent diameter and greater number of implanted stents. Consequently, the final diameter stenosis was significantly better in IVUS guided group. A strategy of routine IVUS for drug-eluting stent implantation in complex coronary lesions did not improve the 1-year MACE rates

Conclusion: use of intravascular ultrasound [IVUS] is associated with lower amount of radiographic contrast used during the procedure, more procedural time, more post dilatation and less postintervention final diameter stenosis. In addition, use of intravascular ultrasound [IVUS] in complex lesions allows proper assessment of minimal lumen area, optimizing PCI procedures and confirming stent well apposition

Epidemiology of prehypertension and hypertension among Egyptian adults

We aimed to describe the prevalence and predictors of prehypertension and hypertension in the Egyptian adult population aged 25 and above. We also described the rates and predictors of awareness, treatment and control of hypertension. Data on 6671 individuals from the 2008 Egypt Demographic and Health Survey [EDHS 2008] were used. Prevalence of prehypertension and hypertension by selected variables was calculated. Logistic regression analysis was used to elicit modifiable risk factors for prehypertension and hypertension, and the population attributable fractions [PAF] for these risk factors were calculated. The prevalence and predictors of awareness, treatment and control for hypertensives were calculated. The overall prevalence rate of prehypertension and hypertension in Egypt were 57.2% and 17.6% respectively. Only 25.2% of the population had normal blood pressure levels of <120/80 mmHg. The highest prevalences of hypertension were found in Ismailia, Alexandria, Menya, Menoufia and Luxor governorates. The prevalence of hypertension among males and females was similar; however, females had a lower prevalence of prehypertension, and a higher prevalence of normal blood pressure, than males. Overweight and obesity were the most important modifiable risk factors of prehypertension and hypertension, accounting for 25% and 56% of the PAF, respectively. The rates of awareness, treatment and control were 54.2%, 43.4% and 21.3% respectively. The most important predictors of awareness were female sex, increasing age, high wealth, and private insurance coverage. No other predictors of treatment and control were found. Mass health education programs should be urgently implemented to encourage the Egyptian population to adopt healthy lifestyles to prevent hypertension and prehypertension, and to control hypertension. Screening and clinical guidelines should be implemented to improve awareness, treatment and control rates among hypertensives

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

OBJECTIVE: In cervico-thoracic junction (CTJ), the use of strong fixation device such as pedicle screw-rod system is often required. Purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels. METHODS: Nineteen patients underwent posterior CTJ fixation with C7 and/or T1 included in fixation levels. Seventeen patients had tumorous conditions and two with post-laminectomy kyphosis. The anatomical features were analyzed for C7 and T1 pedicles in 19 patients using computerized tomography (CT). Pedicle screw and rod fixation system was used in 16 patients. Pedicle violation by screws was evaluated with postoperative CT scan. RESULTS: The mean values of the width, height, stable depth, safety angle, transverse angle, and sagittal angle of C7 pedicles were 6.9 +/- 1.34 mm, 8.23 +/- 1.18 mm, 30.93 +/- 4.65 mm, 26.42 +/- 7.91 degrees, 25.9 +/- 4.83 degrees, and 10.6 +/- 3.39 degrees. At T1 pedicles, anatomic parameters were similar to those of C7. The pedicle violation revealed that 64.1% showed grade I violation and 35.9% showed grade II violation, overall. As for C7 pedicle screw insertion, grade I was 61.5% and grade II 38.5%. At T1 level, grade I was 65.0% and grade II 35.0%. There was no significant difference in violation rate between the whole group, C7, and T1 group. CONCLUSION: C7 pedicles can withstand pedicle screw insertion. C7 pedicle and T1 pedicle are anatomically very similar. With the use of adequate fluoroscopic oblique view, pedicle screw can be safely inserted at C7 and T1 levels.

epidemiology of diabetes mellitus in Egypt: results of a national survey

It is estimated that by the year 2030, Egypt will have at least 8.6 million adults with diabetes. Little data is available on the epidemiology of diabetes in Egypt. We aimed to describe the epidemiology of known diabetes in the adult Egyptian population above the age of 20 years. Data from the 2008 Egypt Demographic and Health Survey [EDHS 2008] were used for this study. Prevalence of diabetes for selected socio-demographic variables was calculated by gender. Prevalence of comorbid conditions, and risk factors for complications of diabetes, were estimated by gender. Health care utilization among diabetics was estimated. The crude prevalence rate of known diabetes in Egypt in 2008 was 4.07% [0.25]. It increased with age, to reach 19.8% among females aged SO-S9. Only 18% of males, and 7.8% of females, had a normal body mass index. 37.S% of male diabetics smoked. The prevalence of hypertension among diabetics was 7S% for males, and 66.9% for females; of these, only 2% of males, and 14.3% of females, were controlled to < 130/80 mmHg. 13.3% of males had a history of myocardial infarction or stroke. 44.9% of males, and 80.4% of females, had no insurance coverage. More than half of diabetics visited a private physician at their last visit. 9.3% of males, and 3.8% of females, had been hospitalized in the past year. Diabetes is highly prevalent among older persons in Egypt. Public health policy should educate the public on the risk factors for diabetes, and should implement guidelines for adequate control of this disease

Cholesterol crystal embolization in a Saudi patient after cardiac surgery-a case report

An eroded atheromatous aorta may be a source of cholesterol crystal embolism[CCE]. Embolization of atheromatous material accounts for obstruction of distal arterioles around which a foreign-body giant cell granuloma inflammatory reaction develops. The diagnosis is often delayed or un recognized because of varying or misleading clinical signs, such as renal insufficiency, digestive or neurological symptoms, or both or unexplained multiple-system disease. Although CCE can occur spontaneously, it has been increasingly recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery. It has also been reported to occur following anticoagulant therapy or thrombolysis. Patients undergoing coronary artery bypass grafting [CABG] often experience a combination of these factors: anticoagulation, intra-arterial angiographic procedures and intraoperative aortic cross-clamping. These multiple factors could account for the acute and severe postoperative clinical and biological findings observed in the case reported here. A 65-year-old Saudi man was admitted to our hospital on July 9, 2008 due to chest pain at rest. He had suffered from type 2 diabetes mellitus on Oral hypoglycemics, hypertension on treatment, impaired renal functions and hypercholesterolemia, he was an ex-smoker with history of diagnosed pulmonary interstitial fibrosis. He had Coronary angiography in another hospital on May 2008 showing a left main lesion 60%, Left anterior descending lesion 90%, circumflex lesion 80% and Right coronary lesion 70%, three weeks later an acute on top of chronic deterioration in renal chemistry was observed for which conservative treatment was chosen

Low pressure pneumoperitoneum laparocopic cholecystectomy is appropriate procedure for cholecystolithiasis in cirrhotic patients

This study aimed to evaluate the feasibility and outcome of laparoscopic cholecystectomy [LC] in cirrhotic patients. All patients presented by symptomatic cholecystolithiasis; the diagnosis was mainly according to the disease history and ultrasound, CT and esophageal barium swallow examination results. Preoperative hepatic function protection and supporting, ascites controlling and portal vein pressure reduction were considered individually for most cases of Child-Pugh [CP] class B and C with attempts to improve the hepatic function of class C patients to near class B level. Only after that, surgical operations arranged were allowed for a safer elective operation. A standard four ports laparoscopic procedure was performed according to the European ifour-puncturet technique using low-pressure pneumoperitoneum [7-9 mmHg]. Conversion rate, duration of surgical procedure, incidence of intra- and postoperative complications, and mean hospital stay were recorded. Patients were followed up for a period of 6 months after surgery. The study included 16 patients; 9 females and 7 males with mean patients' age was 53.5 +/- 5.8; range: 42-61 years. Clinical signs included splenomegally in 12 cases [75%], widened po.tal vein with diameter >14 mm in 10 cases [62.5%], ascites in 5 cases [31.3%], varices of esophagus and gastric fundus veins in 6 cases [37.5%]. Eight patients were class A, 7 were class B and one patient was class C. No conversion to open cholecystectomy [OC], need for a second surgical intervention or perioperative mortality occurred. The average surgical procedure duration was 69.2 +/- 1 Imin; 2 patients [12.5%] had liver bed bleeding and required transfusion of one bag of blood during surgery. The mean time to resume diet was 19.6 +/- 5.8 hours and mean hospital stay was 4.3 +/- 1.4 days. Three patients [18.75%] had postoperative complications: 2 [12.5%] suffered from ascites leading to a worsening of the CP score in one of them, and the third had ischemic chest pain. It could be concluded that LC at low-pressure pneumoperitonium [7-9 mmHg] is an appropriate line of management of cholecystolithiasis in cirrhotic patients and is associated with no mortality or need for return to operating room and acceptable low morbidity rate

Protection against malaria due to innate immunity enhanced by cholesterol free diet

To find out the effect of cholesterol free diet is provision of protections against malaria in mice. Animal faculty of Niigata University Japan. Two groups of mice were fed on normal and cholesterol free diet. Both groups of animals were injected infected erythrocytes. Hepatic lymphocytes, splenocytes and thymocytes were studied by immunofluorescence tests and auto antibodies were measured. Cholesterol of free diet fed mice had complete protection and survived the challenge. possible preventative measures against malaria, because cholesterol free diet rendered mice resistant to lethal strains of P. yoelii and even those of P. berghei

Recurrent varicose veins. Reflection of reflux pattern on the line of management

The aim of this study is to determine whether specific patterns of recurrent varicose veins are associated with the distribution of reflux sites detected clinically and proved by Doppler scanning; also to detect possible causes and evaluate different methods of management. Thirty nine patients with 64 affected limbs with recurrent varicose veins undergoing Doppler scanning and 3 methods of management [2 limbs for conservative therapy; 17 limbs for sclerotherapy; and 45 limbs for surgery]. The main outcome measures of this study is the type and time of previous surgery, sites and causes of reflux, type and sites of new interventions [conservative, sclerotherapy, and surgery], results-and complications. Recurrent varicose veins presented in both legs in 25 patients [64.1%], in left leg only in 9 patient [23.1%], and in right leg only in 5 patients. [12.8%]; ulceration was in 29 patients. [45.2%. Reflux was detected in 19 patients with residual problems in the groin of 28 / 64 affected limbs [43.8%]; 9 limbs [14.1%] with reflux came from epigastric and pudendal veins. Ulceration was associated with higher rates of deep reflux [45.2% versus 54.7% non-ulcerated limbs]. Groin re-dissection was done in 28 / 45 limbs [62.2%]; thigh communicators ligation in 1/64 limbs [2.2%]; and leg perforators sub-facial ligation in 16 / 64 limbs [35.6%]. Complications rate after surgery was encountered in 13 / 45 limbs [28.9%]. The saphenofemoral junction and long saphenous vein remains the key to varicose veins recurrence and Doppler scanning provides a valuable methodology not only to identify multiple sites of reflux hut also to evaluate the adequacy of previous surgery. Because of the efficacy of surgery in treating and preventing recurrence and ulceration, surgical procedures must be selected carefully and by appropriate expertise

Magnetic resonance imaging for primary fistula in ano

This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging [MRI] in primary fistula in ano, and to assess its effect on outcome. Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia [EUA]. Any effect on operative approach was noted. Outcome was assessed at a median of 12 months. Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three [10 per cent]; two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis. In experience hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients

Encephalo-Cranio-cutaneous lipomatosis [ECCL] with cardiac affection case report

Neurocutaneous syndromes are numbers of diseases characterized by collection of neurological and cutaneous manifestations. ECCL is a rare, congenital, neurocutaneous disorder characterized by associated opthalmological affection, first described in 1970 by Haberland and Perou. We reported 4.5 years male child demonstrated the main features of ECCL; cutaneous and neurological manifestations with opthalmological features in the form of conjunctival and corneal dermoids. Some cardiac anomalies were also observed in our patient which were not reported before

Comparative study to evaluate positioning of double-lumen endobroncheal tubes and the correlation between clinical and the role of fiber optic brochoscopy in thoracic anesthesia

Fiber optic bronchoscopy has been recommended to verify and the position of double lumen tubes [DLT], but this remains controversial. We studied the role of brochoscopy for placing and monitoring DLTs, after blind intubation and after positioning of the patient. 25 other patients undergoing thoracotomy were studied. Clinical criteria suggested good positioning in all cases, however, subsequent bronchoscopy revealed mal-position in 4 cases. A DLT was considered mal-positioned when it had to be moved> 0.5 cm to correct its position. Critical mal-position were those that might have affected patients safety or influenced the surgical procedure if left uncorrected. Bronchoscopic finding included bronchial cuff herniation and obstruction of left upper lobe brunchus. So, after blind intubation and the patient positioning, about one fifth of DLTs required repositioning. Routine fiber optic bronchoscopy is therefore recommended after intubation and after patients positioning

Comparative evaluation of intra-articular administration of morphine, bupivacaine and morphine with bupivcaine for post operative analgesia following video knee arthroscopy

Post arthroscopy analgesia has been provided with intra-articular bupivacaine, but the duration of analgesia was short. In contrast intra-articular morphine has been shown to produce significant but delayed post-operative analgesia. So, the combination of intra-articular morphine and bupivacaine may be the ideal analgesic after knee arthroscopoy. Our work was done to clarify this suggestion, seventy five patients ASA grade I and II, aged 20-60 years, undergoing elective knee arthroscopy under general anesthesia, were randomized into three groups: group I received morphine 2 mg in 20cc saline, group II received 20cc of 0.25% of bupivacaine, group III received morphine 2 mg in 20cc of 0.25% of bupivacaine intra-articularly. The visual analogue score [VAS] were performed at 1, 3, 6, 12, and 24 hours post operatively. Group III had significantly lower VAS compared to the other groups at the end of the study, so morphine and bupivacaine provides superior post operative analgesia for up to 24 hours versus bupivacaine or morphine individually

Comparative study to evaluate the effect of alkalinization of lignocaine hydrochioride on supra-clavicular brachial pllexus block

Alkalinization of 2% lignocaine hydrochloride with adrenaline leads to alteration in its onset of action and duration of action. 60 patients requiring upper limb surgery between the age group of 20-60 years of either sex, ASA grade I and II were randomly allocated into three equal groups. Group I received 20 ml of standard 2% lignocaine hydrochloride with adrenaline [pH=3.21]. Group II received 20 ml of freshly prepared solution by addition of 1 ml 8.4% sodium bicarbonate [w/v] to the standard solution [pH=6.21]. Group III received 20 ml of alkalinized standard solution prepared by addition of 2 ml 8.4% sidium bicarbonat [w/v] [pH=6.67]. Supra clavicular brachial plexus block technique was used for drug administration. Onset of sensory block, onset of motor block, quality of block and duration of block was assessed using standard parameters. It was obsrved that raising the pH of the solution from 3.21 to 6.21produced a reduction in latency of sensory block [from 18.35 mins to 10.35mins], a reduction in latency of motor block [from 20.65 mins to 12.2 mins] and increased the duration of block. Further increased of pH from 6.21 to 6.67 did not confer any added advantage. Frequency of complete block in solution with pH 6.21 was seen to increase as compared to pH 3.21 solution [35% to 80%]

Comparative study between lines of treatment on menopausal osteoporotic women

Menopausal women are at high risk for osteoporosis than adult women. This study was carried on 60 postmenopausal women with age ranged 45-65 years old, and the last menses was at least one year before. Bone densimetry was performed for every case to confirm the diagnosis. These cases were classified into four groups: group I [control]: 20 postmenopausal women without osteoporosis and not on treatment. Group II: 20 osteoporotic postmenopausal women and not on treatment. Group III 10 osteoporotic postmenopausal women and on hormone replacement therapy [HRT]. Group IV: 10 osteoporotic postmenopausal women and on vitamin D, calcium and exercise therapy. Lines of treatment include hormonal replacement therapy, calcium supplements, vitamin D, fluoride therapy, calcitonin and diphosphonates. In this study, the most two common lines of treatment [HRT and calcium, vitamin D and exercise] were used and results compared. The urinary deoxypyridinoline links as a marker for bone degradation showed improvement by both lines of therapy. It was significantly decreased when compared to osteoporotic women on no treatment. It is advisable to use calcium supplements, vitamin D and exercise to avoid the hazards of HRT which may include venous thrombosis, fibromyomas and other complications. The success of calcium, vitamin D and exercise to improve osteoporosis make this line of treatment advisable to be used in women as well as in men who suffer from osteoporosis to avoid any hazards of anabolic steroids

Crystalloid versus blood cardioplegia in myocardial preservation during cardiopulmonary bypass

Sixty patients with an age group ranging between 15 and 54 years [mean 40 +/- 4], 26 males and 34 females, arranged in three groups according to the type of cardioplegia used during different types of cardiac surgical procedures performed. The postoperative assessment of myocardial preservation was depended on the hemodynamic affection, laboratory measurement of CPK and LDH and follow up echocardiography. The results showed more efficacy of cold crystalloid cardioplegia and continuous warm cardioplegia to preserve the myocardium in the period of ischemic arrest than cold crystalloid cardioplegia, especially in patients with borderline left ventricular function

Coronary artery revascularization without cardiopulmonary-bypass [OB-CAP] via sternotomy

Twenty-eight patients [93% males and 7% female with an age ranged between 47 and 61 years with a mean of 53.5 +/- 3.7] were included in this study. Five patients had unstable angina, while 25 had stable angina. The internal mammary artery was used in 25 cases and all branches of coronary arteries were bypassed with an average of 2.9 +/- 0.7% grafts per patient [range 2-4]. The initial experience of coronary artery bypass grafting [CABG] without CPB was described using a median sternotomy, the evolution of surgical technique was analyzed and the early clinical results were assessed. It was concluded that this type of surgery is an alternative in the treatment of coronary disease, especially for aged patients with associated disease and can improve the relation cost/benefit

Possible role of lead in liver cirrhosis

In this study, fifteen cirrhotics, thirteen cirrhotics with hepatic encephalopathy and ten normal control persons were subjected to clinical examinations, abdominal sonography, blood biochemistry examination and blood lead determination. Both cirrhotics and cirrhotics with encephalopathy showed symptoms. Physical signs and blood biochemistry changes pertinent with liver cirrhotics, Blood lead concentrations were significantly [p<0.05] higher in cirrhotics and cirrhotics with hepatic encephalopathy than in control persons. We suggest that altered permeability of the blood brain barrier may allow passage of lead into brain tissues contributing to the observed symptoms of hepatic encephalopathy. Chronic liver disease may alter toxicokinetics of lead leading to impaired elimination. Elevated blood lead concentrations would favour the progress of infective liver disease through its immunosupressive effect

Diclofenac versus aspirin in acute rheumatic arthritis

This study was carried out on 60 patients with acute rheumatic arthritis diagnosed according to modified Jones criteria. Cases with carditis was excluded from this study. A thorough clinical examination, blood picture, erythrocyte sedimentation rate [Westergren method], antistreptolysin O titer [modified Rantz and Randall method], ECG and occult blood in stool [Heme-accult test] were done to all Patients